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11. Obstetrics and Gynecology

Normal Cycle: 4 days of menses, then day 5-14 is follicular phase where ovary matures oocyte – Estrogen is produced. Pituitary gland responds to estrogen by producing FSH and LH – this releases matured oocyte. Residual capsule forms corpus luteum. During luteal phase, corpus luteum produces estrogen/progesterone to make endometrium ready for implantation. Corpus luteum waits for HCG which is produced from embryo. If none is produced, corpus luteum regresses and estrogen/progesterone levels fall. When these levels fall, vasoconstriction occurs and lining sloughs/ischemia. Average menstrual blood is 25-60mL (actual blood; endometrial fluid is usually more like 70mL). Average tampon absorbs 20-30mL. In early menarche, periods can vary for the first 1-2 years, sometimes 5 years.

Dysfunctional uterine bleeding: no organic or systemic disease found for cause of bleeding. Ovulatory bleeding: bleeding occurring during ovulation. Tx: oral contraceptives, NSAIDs, danazol (androgen), progestin; consider endometrial ablation or hysterectomy for extreme cases. Anovolutary: in extremes in age – usually due to no ovum so unopposed estrogen – irregular bleeding. You really shouldn’t call the patient’s diagnosis “Dysfunctional uterine bleeding” since you haven’t fully worked the patient up with US, hormone levels, etc. Just call her “Vaginal bleeding.”